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Year in Review: Measles Linked to Disneyland

Throughout the month of December, Public Health Matters is conducting a series of year-in-review posts of some of the most impactful disease outbreaks of 2015. These posts will help explain how CDC is working to prevent, identify, and respond to these outbreaks.

Measles in Disneyland

After an uncharacteristically high number of measles cases in late 2014, the highly publicized California measles outbreak hit the media early this year. Linked to Disneyland Resort Theme Parks in California the outbreak quickly became a multi-state public health incident that resulted in a total of 147 cases. Cases related to this outbreak were identified in seven states in the U.S., as well as Mexico and Canada.

Attention to this outbreak was further fueled by the interest surrounding vaccinations. Among the reported measles cases, the majority of patients were unvaccinated or had an unknown or undocumented vaccination status.

Why a Measles Outbreak in the U.S. is a Big Deal

In 2000, the United States declared that measles was eliminated from this country. The elimination of measles in the U.S. was due to a highly effective measles vaccine, a strong vaccination program that achieves high vaccine coverage in children, and a strong public health system for detecting and responding to measles cases and outbreaks.

Before a measles vaccine became available in 1963, 3 to 4 million people in the United States were infected with measles each year, resulting in an estimated 48,000 hospitalizations and 400 to 500 deaths. Most people in the U.S. today are protected against measles through vaccination, so measles cases are uncommon compared to the number of cases before a vaccine was available. However, the risk of measles re-establishing itself as a prominent disease in the U.S. is possible—especially if vaccine coverage levels drop.

Today, measles is still endemic in many parts of the world, and measles outbreaks in the U.S. occur when measles is brought into the United States by unvaccinated travelers (Americans or foreign visitors) who get measles while they are in other countries. These travelers can spread measles to other people who are not protected against the disease, which sometimes leads to outbreaks. While the source of the Disneyland-associated measles outbreak was not identified, it is likely that a traveler (or more than one traveler) who was infected with measles overseas visited one or both of the Disney parks in December during their infectious period and infected other visitors to the park.

Measles: a Serious Sickness

Measles is extremely contagious. It is so contagious that if one person has it, 90% of the people close to the person who are not immune will be infected. You can catch measles just by being in the same room as a person with measles. Even if the infected person has left the room, the virus can live for up to two hours in an airspace where the infected person coughed or sneezed. The measles virus lives in the nose and throat mucus of an infected person, and can spread to others through coughing and sneezing.

Common symptoms of measles include, high fever, cough, runny nose, red, watery eyes, and a rash 3-5 days after symptoms begin. In some cases complications from measles can result in pneumonia, encephalitis (swelling of the brain), and death.

People at high risk for severe illness and complications from measles include, infants and children under 5 years of age, adults over the age of 20, pregnant women, and people with compromised immune systems.

What can be done to protect the public from measles outbreaks?

State and local health departments lead investigations of measles cases and outbreaks when they occur. CDC helps and supports health departments in these investigations and continually gathers data reported by states on confirmed measles cases to provide evaluation and monitoring from a national perspective.

High sustained measles vaccine coverage and rapid public health response are critical for preventing and controlling measles cases and outbreaks. It is possible to get rid of measles in the U.S. completely, but the first step is to eliminate measles from each country and region of the world. Once this happens, there will be no place from which measles can spread.

Until measles is eliminated worldwide, it remains a risk to any unvaccinated person exposed to the virus. Do your part to protect yourself, your family, and those around you from measles and make sure you and everyone in your family who is eligible gets vaccinated. The best protection against measles is measles-mumps-rubella (MMR) vaccine. MMR vaccine provides long-lasting protection against all strains of measles.

To learn more about measles, the MMR vaccine, and CDC’s efforts to reduce the number of measles case worldwide visit CDC’s Measles webpage.

3 comments on “Year in Review: Measles Linked to Disneyland”

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I can agree with how outbreaks can affect the people around you. As an educator, I had 15 student break out with chicken pox. Since the entire class was affected, the health department was notified and the information was recorded. I also had to get a vaccine to help prevent with any other interactions or reactions.

The outbreak at Disneyland put the spotlight back on immunizations and their importance. We have known for some time that diseases that have been previously eradicated, can become prevalent again as some diseases have only been eradicated in this country. There have been a lot of immunizations added to the recommended schedule over the years as well. The Hepatitis B vaccine was once a vaccine offered to healthcare workers and others deemed at risk. Today, newborns are offered the Hepatitis B vaccine before they leave the hospital. I have also seen a trend change that speaks to the visitors who developed measles who had a history of getting immunized. As a nurse, hospitals historically required an immunization record from new employees. Now I have seen a shift to hospitals wanting a titer drawn. I think this is excellent because we do not always know the immunity status of those who have been immunized. My question would be is this the shift for the future? Will schools one day require titer records instead of immunization records? It is an accurate reflection of one’s immunity.

Being an Infection Control Coordinator/Employee Health Nurse for a large Health System, I am very familiar with the requirements for employees within the health care field. They have switched over to tittering employees to see if they have immunity to hepatitis B, varicella, measles, mumps, and rubella. School systems only require proof of vaccination, however just because you have received the vaccine does not guarantee that you are immune the the disease, a titer is the only way to determine immunity. It is imperative that all children who are capable of receiving the vaccine get it. This will not only protect that child but it will help protect the children who cannot receive vaccines due to allergies or other contraindications.

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